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Orthopaedic Resident Preparedness for Closed Reduction and Pinning of Pediatric Supracondylar Fractures Is Improved by e-LearningA Multisite Randomized Controlled Study
Thomas Hearty, MD, DPT1; Max Maizels, MD2; Maya Pring, MD3; John Mazur, MD4; Raymond Liu, MD5; John Sarwark, MD2; Joseph Janicki, MD2
1 U.S. Naval Hospital Okinawa, PSC 482, Box 2607, FPO, AP 96362. E-mail address for T. Hearty: Thomas.hearty@med.navy.mil
2 Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Chicago, IL 60611
3 Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA 92123
4 Nemours Children’s Clinic, 807 Childrens Way, Jacksonville, FL 32207
5 University Hospitals Rainbow Babies & Children’s Hospital, 11100 Euclid Avenue, Suite 5100, Cleveland, OH 44106
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Investigation performed at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio, Rady’s Children’s Hospital San Diego, San Diego, California, and Nemours Children’s Clinic, Jacksonville, Florida

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, the Department of the Navy, the Department of Defense, or the United States Government. One author (Thomas Hearty, MD, DPT) is an employee of the United States government. This work was prepared as part of his official duties and, as such, there is no copyright to be transferred.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Sep 04;95(17):e126 1-7. doi: 10.2106/JBJS.L.01065
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There is a need to provide more efficient surgical training methods for orthopaedic residents. E-learning could possibly increase resident surgical preparedness, confidence, and comfort for surgery. Using closed reduction and pinning of pediatric supracondylar humeral fractures as the index case, we hypothesized that e-learning could increase resident knowledge acquisition for case preparation in the operating room.


An e-learning surgical training module was created on the Computer Enhanced Visual Learning platform. The module provides a detailed and focused road map of the procedure utilizing a multimedia format. A multisite prospective randomized controlled study design compared residents who used a textbook for case preparation (control group) with residents who used the same textbook plus completed the e-learning module (test group). All subjects completed a sixty-question test on the theory and methods of the case. After completion of the test, the control group then completed the module as well. All subjects were surveyed on their opinion regarding the effectiveness of the module after performing an actual surgical case.


Twenty-eight subjects with no previous experience in this surgery were enrolled at four academic centers. Subjects were randomized into two equal groups. The test group scored significantly better (p < 0.001) and demonstrated competence on the test compared with the control group; the mean correct test score (and standard deviation) was 90.9% ± 6.8% for the test group and 73.5% ± 6.4% for the control group. All residents surveyed (n = 27) agreed that the module is a useful supplement to traditional methods for case preparation and twenty-two of twenty-seven residents agreed that it reduced their anxiety during the case and improved their attention to surgical detail.


E-learning using the Computer Enhanced Visual Learning platform significantly improved preparedness, confidence, and comfort with percutaneous closed reduction and pinning of a pediatric supracondylar humeral fracture. We believe that adapting such methods into residency training programs will improve efficiency in surgical training.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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